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MEDICAL WASTE GENERATOR <br /> FILE COVER SHEET <br /> FACILITY ID#: FA0013665 P/E: 4530 DATE: 01/07/2009 <br /> PROGRAM RECORD#: PR0522691 PSE: DATE: <br /> P/E: DATE: <br /> ADDRESS: 1156 S MAIN ST CITY: MANTECA <br /> CILITY NAME (DSA): DAVITA MANTECA DIALYSIS CENTER <br /> CILITY PHONE: (209) 823-3078 FACILITY FAX: <br /> FACILITY CONTACT: LICENSURE & CERTIFICATION DEPT PHONE: <br /> OWNER NAME: DAVITA INC CITY: TACOMA <br /> NER ADDRESS: 1423 PACIFIC AVE PHONE: (800)477-1916 <br /> Water Service: ❑ Large PWS ❑ Small PWS ❑ Domestic Well <br /> Sewer Service: ❑ Public Sewer ❑ OnSite WWTX ❑ OnSite Septic System <br /> Stormwater: ❑ Street Drains ❑ Street Ditches ❑ OnSite Ponds ❑ Other <br /> EH 00 18 rev 05/2007 <br /> rpt#: MWCS New Owner: Create a New Cover Sheet/Change Label of File <br />